| Background:End-stage renal disease is caused by various kidney diseases that lead to irreversible decline of kidney function.Maintenance hemodialysis is the most common renal replacement therapy.Despite advances in medical technology,the mortality rate of end-stage renal disease dialysis patients remains at about 22.8%per year.Cardiovascular disease is the leading cause of death in patients with chronic kidney disease.The short-term effects of hemodialysis modality on cardiac function during dialysis and its pathogenesis,and the correlation of biochemical markers(serum calcium,phosphorus,and parathyroid hormone)with the risk of cardiovascular events and all-cause mortality are inconclusive.Objective:1.To evaluate the short-term effects of pre-dilution hemodiafiltration and hemodialysis on left ventricular systolic function during dialysis.2.The correlation between the changes of biochemical indexes and left ventricular systolic function before and after a single hemodialysis was analyzed.3.To analyze the correlation between the average level and variation of serum calcium,phosphorus and parathyroid hormone and death and cardiovascular events.Methods:1.This cross-design clinical trial enrolled 38 maintenance hemodialysis patients who were randomly assigned to one of two treatment sequences:one week of prediluted hemodialysis or hemodialysis,a 2-day washout period,followed by another modality of treatment for one week.Left ventricular systolic function was assessed by echocardiography before and after midweek treatment.2.This part of the study included 38 patients with maintenance hemodialysis,and analyzed the correlation between blood calcium,phosphorus,urea nitrogen,β2microglobulin and other biochemical indexes before and after a single hemodialysis,and cardiac color ultrasound indexes to evaluate left ventricular systolic function.3.This observational cohort study included 122 patients who were enrolled in dialysis until 31 December 2017.Biochemical markers(including blood calcium,phosphorus,parathyroid hormone,and albumin)were measured once per quarter and up to 20 times.All-cause deaths and cardiovascular events were prospectively tracked for survival analysis between January 1,2018 and December 31,2022.Results:1.After hemodiafiltration,the mean systolic velocity at mitral annulus septum and lateral wall increased from 6.74±1.23 to 6.98±1.56 cm/s(P=0.246),and after hemodialysis increased from 6.71 ± 1.34 to 7.44±2.18 cm/s(P=0.039).The range of motion of the interventricular septum at the papillary muscle level was-3.77±3.88 mm before and after hemodialysis and-0.32±2.84 mm before and after hemodialysis(cross analysis P=0.004).The septal motion amplitude of papillary muscle level decreased significantly from 9.24±4.25 mm to 5.47±3.65 mm after hemodialysis(P=0.002),and from 6.96±3.69 mm to 6.64±3.51 mm after hemodialysis(P=0.659).2.Stroke output after dialysis was negatively correlated with blood calcium(0.378,P<0.05).The stroke output was negatively correlated with the β2-microglobulin decline rate(-0.385,P<0.05).3.The greater the degree of parathyroid hormone variation(coefficient of variation,standard deviation,range),the higher the risk of cardiovascular events.High serum calcium levels significantly increased the risk of death.High blood phosphorus levels significantly increased the risk of death.Conclusion:1.Compared with hemodialysis,hemodiafiltration causes decreased left ventricular systolic function during dialysis in maintenance hemodialysis patients.2.Serum calcium level after single hemodialysis was negatively correlated with left ventricular systolic function.3.High parathyroid hormone variability increases the risk of cardiovascular events in maintenance hemodialysis patients.High blood calcium and phosphorus levels increase the risk of death in maintenance hemodialysis patients. |
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